BNP动态分析对老年急性心力衰竭患者肾功能恶化风险的预测价值

The predictive value of BNP dynamic analysis for the risk of worsening renal function in elderly patients with acute heart failure

目的探讨脑钠肽(BNP)动态分析用于早期预测老年急性心力衰竭(简称急性心衰)患者发生肾功能恶化(WRF)的价值。方法将2017年9月至2020年3月该院收治的117例老年急性心衰患者纳入研究。收集所有患者临床资料,测定患者入院时、入院72 h的BNP水平,由此计算BNP差值(ΔBNP)、BNP降幅。根据患者入院7 d至出院时是否发生WRF分为WRF组和非WRF组,比较两组患者的临床资料。采用多因素Logistic回归分析老年急性心衰患者发生WRF的独立影响因素。绘制受试者工作特征(ROC)曲线,评估BNP动态分析指标用于早期预测老年急性心衰患者发生WRF的效能。结果入院7 d至出院时,共35例患者发生WRF,发生率为29.91%(35/117)。WRF组和非WRF组患者临床资料的比较显示,WRF组基线eGRF水平低于非WRF组,入院7 d袢利尿剂总剂量高于非WRF组,ΔBNP、BNP降幅低于非WRF组,差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,基线eGRF水平、ΔBNP、BNP降幅是老年急性心衰患者发生WRF的保护因素(OR<1,P<0.05);ROC曲线分析显示,BNP降幅用于早期预测老年急性心衰患者发生WRF的曲线下面积为0.861,高于ΔBNP和基线eGRF水平(P<0.05),截断值为30.11%,预测灵敏度为71.43%,特异度为90.24%。结论BNP动态分析有助于早期预测老年急性心衰患者发生WRF,入院72 h后BNP降幅不足30%的患者需要临床医生重点关注。

Objective To investigate the value of brain natriuretic peptide(BNP)dynamic analysis for early prediction of worsening of renal function(WRF)in elderly patients with acute heart failure.Methods A total of 117 elderly patients with acute heart failure admitted to the hospital from September 2017 to March 2020 were enrolled in the study.Collected the clinical data of all the patients;measured their BNP levels at the time of admission and 72 h after admission,and calculate the difference of BNP level(ΔBNP)and the reduction of BNP.Patients were divided into WRF group and non WRF group according to whether they had WRF from 7 d after admission to the time of discharge,and the clinical data of the two groups were compared.Multivariate Logistic regression was used to analyze the independent influencing factors of WRF in elderly patients with acute heart failure.Receiver operating characteristic(ROC)curve was used to evaluate the effectiveness of BNP dynamic analysis for early prediction of WRF in elderly patients with acute heart failure.Results From 7 d after admission to discharge,a total of 35 patients developed WRF,with an incidence of 29.91%(35/117).The comparison of clinical data between WRF group and non WRF group showed that the baseline eGFR level was lower and the total dose of loop diuretics 7 d after admission in WRF group was higher than those in non WRF group,ΔBNP and reduction of BNP were lower than those in non WRF group(P<0.05).Multivariate Logistic regression analysis showed that the baseline eGFR level,ΔBNP and reduction of BNP were the protective factors of WRF in elderly patients with acute heart failure(OR<1,P<0.05).ROC curve analysis showed that the area under the curve of BNP reduction for early prediction of WRF in elderly patients with acute heart failure was 0.861,which was higher thanΔBNP and baseline eGFR levels(P<0.05),the cut-off value was 30.11%,the predictive sensitivity was 71.43%,and the specificity was 90.24%.Conclusion BNP dynamic analysis can help early predict the occurrence of WRF in elderly patients with acute heart failure.Patients with a BNP reduction less than 30%72 h after admission need the clinicians′s attention.